A projected $500,000 deficit this fiscal year forced the Portland Community Health Center to eliminate the job of the chief program officer who oversaw its behavioral health program as well as a program director effective Jan. 1.

Two more positions – practice manager and a clinical social worker – remain unfilled, said CEO Leslie Clark.

“We were already bare-boned at the administration level,” Clark said. “Where we took all the hits has been in management so we’re down to our senior team of really three people – myself, a chief financial officer and a chief medical officer.”

The Portland Community Health Center serves the highest percentage of uninsured people among Maine’s 19 Federally Qualified Health Centers (FQHC), a safety net designation that makes them eligible for reimbursement from the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services.

That is having a profound impact on the bottom line of the Portland nonprofit, which has a staff of 47 and a nearly $4.1 million annual budget. Clark said the center’s board of directors may eventually have to decide whether to stop taking new patients.

Maine Gov. Paul LePage has trimmed about 63,000 non-disabled, working age adults from his state’s Medicaid rolls over the past four years to bring Medicaid spending under control after years of red ink.

That reduction has allowed LePage to shift $26 million to assist struggling nursing homes, fund $46 million in services for elderly and severely disabled Mainers on Medicaid waitlists, add $28 million to the state’s investment in Medicaid recipients’ access to primary care providers and fulfill obligations to the mentally ill with $14 million in new funding in his administration’s two-year, 2015-17 budget released in January.

MaineCare – the name for the state’s Medicaid program – doubled in cost, enrollment, and as a share of the state budget from 2001 to 2011, when Gov. LePage took office. In 2011, the percentage of Maine’s population enrolled in Medicaid stood at 26 percent, higher than the national average of 18 percent. The state’s Medicaid enrollment now matches the national average at 22 percent.

“Maine has made the decision to finally prioritize the truly needy after decades spent expanding our welfare system to more and more able-bodied adults,” Maine Department of Health and Human Services spokesman David Sorensen said in an email. “We face no budget shortfall for fiscal years 2016-2017 as a result,” Sorensen said.

But Ann Woloson, policy analyst with Maine Equal Justice Project, said the governor’s budget is based on “false choices.” She noted the state budget has provided significant tax cuts over the last couple of years.

“Pitting one population over another population is not good policy from our perspective,” Woloson said.

Community health centers have been recognized for reducing higher spending downstream, by avoiding unnecessary hospitalizations and costly emergency room visits. In 2011, Maine’s community health centers provided care to 19 percent of the Medicaid population, while accounting for only 1.1 percent of the total state Medicaid expenditures, according to the Maine Primary Care Association.

There were four full time equivalent psychologists practicing in Maine community health centers as of 2013, according to Health Resources and Service Administration data. (The data only surveyed 14 of the state’s 19 FQHCs).

Hampden clinical psychologist Diana L. Prescott, Ph.D., who has served on the Maine Primary Care Association’s Board of Directors since October 2010, said the MaineCare cuts pose a setback for a longstanding goal to increase the number of psychologists in community health centers.

“I haven’t given up hope,” Prescott said. “It’s a hard time for health centers. It’s difficult keeping doors open in some cases,” Prescott said.

Portland Community Health Center had 5,376 active patients in 2014. About 46 percent were uninsured, up from 32 percent in 2010. Patient data show the increase continues: 53 percent of patients were uninsured in January.

A patient without insurance pays out of pocket for treatment on a sliding fee scale that is zero for a homeless individual or from $10 to a maximum of $35 based on federally established poverty guidelines. But if the patient has MaineCare, the state would reimburse the Portland Community Health Center approximately $180 for each treatment encounter, depending on the services provided.

An FQHC designation means a clinic cannot turn away a patient based on their ability to pay. But Clark said the financial constraints are forcing the Portland Community Health Center’s board of directors to consider making difficult choices.

“The part that we’re grappling with is the board could decide to just stop taking any new patients for some period,” she said. “There’s just no way to cut our way out of this any further.”

A new adult patient who calls the Portland Community Health Center has about a four-week wait for an appointment, though children can be seen right away, Clark said.

Clark continued: “We’re still covering every team. People are just working longer and harder, I will say it’s not sustainable. People can work this way for a period of time when there’s a light at the end of the tunnel. At some point, we are worried about burnout and the impact on our staff.”

A bill submitted by Sen. Roger Katz (R-Augusta) and Rep. John Martin (D-Eagle Lake) with support from the Maine Primary Care Association would direct $3 million in state funding out of the general fund over two years to offset the MaineCare cuts and reimburse community health centers for treatment of the uninsured.

“That funding if it goes through, which is a big if,” Clark said, “for the Portland Community Health Center – that would be a really big help.”